Postoperative complications
Learning objectives
1. List the steps to obtain an accurate and through assessment of pts. Prior to ,
during and after surgery .
2. Describe the development and management of postoperative nausea and
vomiting (PONV) .
3. Discus the signs and symptoms as well as treatment of malignant
hyperthermia .
4. Review the implications of hypothermia , pain and complication related to
positioning in postsurgical pts .
5. List the most common respiratory complication following surgery and how to
best identify and manage these complications in the postanesthesia care until
(PACU) .
6. Develop a plan for assessment and management to de instituted in the PACU
to limit the development of postoperative complication .
Assessment of the postsurgical patient
Reducing the risk of postoperative can be accomplished with a through assessment
of the pt. upon arrival in the PACU . A complete systems assessment should be
completed within the first 5 minutes of arrival in the PACU .
Objective of POC
Risk reduction measures should be instituted early on the course of care to decrease
the incidence of complicating factors that can lead to prolonged disability and even
death .
Parameters should be Assessed when a patient is admitted to the PACU .
1. Airway , circulation and Breathing responses (ACBs) .
2. Vital sign assessment is performed on a regular basis
3. Postoperative Neurologic status is also important to assess , recognizing that
the patient will continue to fluctuate from an alert status to a somnolent
state.
4. Assessing pain should be performed as soon as the patient is stabilized in the
PACU .
5. Wound and skin assessment should be performed , including assessment of
the surgical site as well as any area that were prone to pressure while under
anesthesia .
6. Core body temperature reading should be attained . Hypothermia is common
in the postoperative phase .
7. Complaint of nausea and vomiting is frequent in the recovery phase . It is
important to determine which medications , if any , were administered in the
operative phase of care to manage postoperative nausea and vomiting .
8. The GI and genitourinary GU system require assessment , the shape and size
of abdomen should be noted , and any alteration should be re-evaluated
every 15 – 30 minutes .
9. Medication administration must be considered . IV sites should be assessed
for patency , as catheters commonly remain in place until the time of
discharge .
10.Pts. , often leave the operating room with many drains and tubes . these
devices should be checked for proper functioning and the site documented .
Nasogastric , Urinary , and chest drainage should be collected , measured ,
and noted on the intake / output record .
11.Fluid and electrolyte status should be assessed when time permits . Blood loss
and third spacing of fluid can all impact fluid balance .
12.The emotional state of the pt. must be included in the postsurgical
assessment .
Ref :- Flanagan , Alice , Continuing Education for California Nurses , postoperative
complication , CMEJ . Vol , 135 , No. 6 2010 , calfornia .